The Falls and Fractures Clinic – An Integrated Model of Care for Osteosarcopenic Patients

Abstract

Osteosarcopenia is a newly described syndrome that features the coexistence of osteoporosis and sarcopenia, two chronic musculoskeletal conditions associated with aging. Researchers estimate that between 10% and 40% of community-dwelling individuals over the age of 65 years have osteosarcopenia. Several studies have confirmed that sarcopenia and osteoporosis share common risk factors and biological pathways. The consequences of osteosarcopenia include higher risk of falls, fractures, hospitalization, disability, poorer quality of life, increased morbidity, institutionalization, and death. High-risk osteosarcopenic patients and their outcomes should be clearly identified and treated to avoid the catastrophic consequences of the “hazardous duet” of falls due to sarcopenia and fractures due to osteoporosis, which results in high healthcare costs. Several models of care have been established for management and treatment of outcomes of osteosarcopenia. However, no model of care for patients with osteosarcopenia has been proposed thus far. By increasing our understanding of the bone-muscle unit, effective therapeutic interventions could be offered for patients with osteosarcopenia. This chapter discusses several models of care for outcomes of osteosarcopenia, including falls clinics, orthogeriatric models of care for low-trauma fragility fractures, and fracture liaison services for evaluation and management of patients with osteoporotic fractures. Finally, a specific model of care for osteosarcopenic patients is discussed, and some aspects related to organization, administration, client characteristics, and interventions based on the literature are described. Furthermore, a process flow diagram for a falls and fractures clinic is proposed. Based on the comprehensive geriatric assessment (CGA), the most important aspects in the evaluation of osteosarcopenic patients are described, and remarks are given on key concepts of their management in a falls and fractures clinic.